Healthcare Provider Details

I. General information

NPI: 1992898779
Provider Name (Legal Business Name): SHAUNA RAE HURSEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

IV. Provider business mailing address

415 N SPRUCE ST
EBENSBURG PA
15931-1225
US

V. Phone/Fax

Practice location:
  • Phone: 814-534-3931
  • Fax:
Mailing address:
  • Phone: 814-270-1085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN526802L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: